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Review Protocol – Angina specific specialised pain interventions

Review questionWhat is the clinical/cost effectiveness of (angina specific) specialised pain interventions in patients with stable angina?
  1. Adults with a diagnosis of stable angina
    • including people with diabetes, South Asians, women, minimal coronary heart disease
InterventionPain management
  • TENS (Transcutaneous electric nerve stimulation),
  • Spinal cord stimulation (NICE TA),
  • Cognitive Behavioral Therapy,
  • Temporary or destructive sympathectomy,
  • Analgesics (including opioids – oral, transdermal, epidural, transthecal.)
  • Myocardial laser (percutaneous or transmyocardial) (NICE TA)
  • EECP (Enhanced external counter pulsation)
  • Acupuncture
  • Head to head comparison of pain interventions
  • Compared to no treatment (no angina specific pain intervention)
OutcomesImprovement in Anginal symptoms-
Angina frequency (No. of anginal attacks)
Nitroglycerin consumption

Mortality @ longest available evaluation time point (preferred 5yr, 10 yr)
Preferred outcomes:
  • All cause mortality
  • Cardiac mortality
Other outcomes:
  • Cardiovascular mortality
Exercise tolerance (based on repeat of baseline ETT at a min of 3m follow up)
Preferred outcomes: Major cardiac events @ longest available evaluation time point (preferred 1yr, 5yr, 10yr)

Preferred outcome:
  • Nonfatal MI
Hospitalisation @ 6m -1yr

Revascularisation @ 1yr, 5yr, 10yr if available

Quality of Life eg EQ-5D, SF-36, HAD, etc @ longest available evaluation timepoint (preferred 1y, 5y, 10y)

Adverse events
Search strategyThe databases to be searched are, Medline, Embase, The Cochrane Library, CINAHL, Registry databases.

Cohort studies will be considered if no RCT evidence available.

Studies will be restricted to English language only

No date restriction will be applied. Databases will be searched from their date of origin
Search termsTENS/transcutaneous nerve stimulation
Spinal cord stimulation
EECP/ enhanced external counterpulsation
Myocardial laser


Analgaesics (oral, transdemal, epidural, transthecal routes) NSAIDS/ opioids/ -Others
The review strategy

From: Appendix C, Review Protocols

Cover of Stable Angina
Stable Angina: Methods, Evidence & Guidance [Internet].
NICE Clinical Guidelines, No. 126.
National Clinical Guidelines Centre (UK).
Copyright © 2011, National Clinical Guidelines Centre.

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